Professor Tamsin Ford

Professor of Child and Adolescent Psychiatry at the University of Cambridge - Tamsin is Research Chair at Place2Be. She is an internationally renowned Child Psychiatric Epidemiologist who researches the organisation, delivery, and effectiveness of services and interventions for children and young people’s mental health.

Jennifer Saxton

Research Associate at the University of Cambridge - Jennifer is a mixed methods researcher, with a particular interest in interventions to improve young people’s mental health and reduce inequalities. Her recent projects include an evaluation of Place2Be's one-to-one counselling intervention, and the HOPE study.

Professor Tamsin Ford and Jennifer Saxton of the University of Cambridge reflect on the recent SEND (special educational needs and disability) consultation and share their wishes for reforming SEND services in England. 

Like many concerned parent-carers, young people and practitioners, the recent SEND Green Paper and consultation have got us thinking about how much we need to improve the identification and support for children with SEND.

The relationships between mental health, SEND, and education is complicated. SEND is more common among children with poor mental health. Unsurprisingly, struggling with schoolwork due to a learning or physical health difficulty may precipitate or maintain mental health conditions.

These children are doing the academic equivalent of running to keep up with their peers who may stroll through the curriculum. Academic progress can be hampered by poor mental health through impaired attention, memory and motivation. Some mental health conditions, such as Attention Deficit Hyperactivity Disorder (ADHD), may also require SEN support or an Education, Health and Care Plan (EHCP).

Education settings can trigger anxiety among children. This can be due to the sensory and social challenges of school, academic pressures, bullying and uncertainty about change. Environmental shocks such as the COVID-19 pandemic disproportionately affect disadvantaged groups, exacerbating inequalities. Several studies suggest that children with SEND were more likely than their peers to experience worsened mental health during the pandemic.

SEND is also more common among children living in socio-economically deprived circumstances. Given the poor access to remote schooling children face in deprived areas, they will have more to catch up on and will need longer to do so.

Amongst these complex challenges is the unenviable task of designing an effective system to ensure every child with SEND gets the right support, in the right place, at the right time. That is the aim of the recent SEND review.

The Department of Education (DfE) outline three key challenges that their policy reforms aim to overcome:

1. Outcomes are worse on every measure for children with SEND than their peers without SEND.
2. Navigating the current system is bureaucratic and adversarial for children and families, with inconsistent practice at local authority level.
3. The current system does not provide good value for money.   

Work on the Health Outcomes for Young People throughout Education (HOPE) study (University of Cambridge), including listening to parent-carers and young people, resonates strongly with these challenges – particularly the second point. If policy reform can streamline the SEND pathway, then many obstacles to overcoming other problems are likely to diminish.

Embedding children’s rights principles into SEND policy and practice will improve the experience of children and their families and future outcomes. Here we describe three rights-based wishes for the proposed reforms.

Reframe policy language about children with SEND: from individuals ‘with needs’ to those with 'entitlements to have their needs met.'

The UN Convention on the Rights of the Child (CRC) articulates an indivisible set of children’s rights, including the right to an education, no matter who they are. These principles align with the 2014 Children and Families Act upon which the SEND Code of Practice (COP) is based.

One reason the SEND system is adversarial for families stems from inconsistent local authority interpretation of the SEND COP, in which children’s rights language is lost amongst the more subjective language of needs. Case studies demonstrate that when policy language makes children's rights explicit, adherence to legislation improves, with positive effects in childhood and the longer term.

Improve accountability mechanisms at local authority level through strengthened monitoring and evaluation.

Critical to operationalising children’s rights is the principle of accountability: there is no point in having rights without corresponding obligations on duty-bearers to fulfil them. These include legal redress for parents and carers, Ofsted/CQC local area inspections for SEND, and data insight tools such as LG-inform, which allows users to see the relative performance of local authorities based on government SEND data. Data insight tools hold great potential for strengthening accountability.

If such actions are triggered when standards drop below agreed thresholds, remedies for children will be timelier. If SEND data are further disaggregated (e.g. by ethnicity), they will show which groups are included and which are left behind.

Data disaggregation has been encouraged in the reporting of sustainable development goals as a way of addressing inequalities through the power of data to 'concentrate effort and attention.' More effective monitoring and evaluation will also highlight good practice, which can be harnessed for quality improvement. 

Include a mandate to include children and families in all decisions that affect them.

Decision-making should be transparent and include the voice of parent-carers and children at every step. Currently, parent-carers and children are excluded from EHCP panel meetings, and meeting minutes are not shared with them.

Formally including children and families in proposed ‘SEND partnerships’ to develop plans for how local areas will improve responsiveness.

Greater transparency and involvement of children and families as experts in all decision-making that affects them should reduce unfair local variation in services. With greater openness, greater trust between parent-carers, children and professionals will follow and lessen the unhelpful adversarial nature of the current system.   

Meanwhile, Place2Be continues to offer children and parent-carers mental health support to navigate the system. 

Read more about how we support young people with SEND